Introduction: Surgical Excision of Melanoma

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Moderator, Mario Sznol, MD, introduces a panel discussion focused on clinical advances and practical considerations in the treatment of patients with metastatic melanoma. The discussion includes expert perspectives from Robert H. I. Andtbacka, MD, CM, Omid Hamid, MD, Merrick I. Ross, MD, Jeffrey A. Sosman, MD, and Jeffrey S. Weber, MD, PhD.

Approximately 85% of patients present with clinically localized melanoma and are candidates for surgical resection, Ross notes. Long-term regional control and potential cure with minimal morbidity are the primary goals for excision. The margins used during surgery are generally based on tumor thickness, notes Ross. For the purpose of achieving a cure, lymph node disease should be treated early.

When considering surgical management, the parameters for selecting a patient for sentinel lymph node biopsy (SLNB) have evolved in recent years, notes Robert H. I. Andtbacka, MD, CM. In many cases, SLNB is now utilized in earlier stage disease in order to detect micrometastatic disease. In resectable stage III melanoma, SLNB has traditionally been indicated for tumors above 1 mm in size. However, Andtbacka suggests that .75 mm may be a better measurement. In addition to Breslow thickness, a high mitotic rate can be utilized to determine the need for SLNB, Andtbacka adds